右美托咪定与丙泊酚对老年患者POCD发生率的影响

Effects of dexmedetomidine and propofol on POCD in the elderly people

目的比较右美托咪定与丙泊酚对老年患者术后认知功能障碍(POCD)发生率的影响并探讨相关机制。方法将100例测试者随机分为右美托咪定组(DEX组)和丙泊酚组(Prop组),每组50例。DEX组给予七氟醚+右美托咪定麻醉,Prop组给予七氟醚+丙泊酚麻醉。比较两组患者术中平均动脉压(MAP)、心率(HR)及血氧饱和度(SpO_2)值变化;于术前1 d、术后1 d和3 d对患者进行简易智能量表(MMSE)评分,采用ELISA及试剂盒法检测血清中白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、S100β、超氧化物歧化酶(SOD)表达量的变化。结果 DEX组患者MAP、HR值较Prop组更为稳定,术后1 d、3 d POCD发生率显著降低(P<0.05),血清中IL-6、TNF-α、S100β值降低(P<0.05),SOD值升高(P<0.05)。结论术中使用右美托咪定较丙泊酚能更有效降低炎症及氧化应激反应,从而缓解了老年患者POCD。

Objective To compare the effects of dexmedetomidine and propofol on postoperative cognitive function in elderly patients and explore the related mechanisms. Methods The 100 cases participants were randomly divided into dexmedetomidine group（DEX group） and propofol group（Prop group）. Each group included 50 patients. DEX group patients received sevoflurane and dexmedetomidine while Prop group received sevoflurane and propofol. Intraoperative MAP,HR and SpO_2 values were compared. MMSE scores at 1 d before operation and 1 d,3 d after operation were recorded. Serumexpressions of interleukin-6（IL-6）,tumor necrosis factor alpha（TNF-α）,S100β and superoxide dismutase（SOD）were tested by ELISA or assay kits. Results Compared with Prop group,MAP and HR rate of patients of DEX group were more stable and the incidence of POCD at 1 d and 3 d after operation were significantly lower. Serum expressions of IL-6,TNF-α,S100β were significantly decreased and expression of SOD was increased. Conclusion Intraoperative use of dexmedetomidine compared with propofol was more effective to reduce inflammation and oxidative stress,thus alleviating postoperative cognitive dysfunction in elderly people.